Malaysia

Migration is a widespread phenomenon throughout the world and it has been under way since time immemorial. While studies have focused on the causes of migration and the impact of migrants, studies focusing on the emotional experience of the left-behind older persons’ adjustments in their twilight years after the departure of their adult children, are few and far between. Thus, the perspectives of these left-behind older parents/ persons are less understood. This paper aims to contribute to the literature by addressing the gap which will be filled through the experiences of left-behind Malaysian older persons. Drawing on in-depth interviews extracted from a qualitative study that focused on the strength of long-term marriages among Malaysian Chinese couples, this paper captures four older couples’ experiences that depict their feelings about their adult children’s migration. Analysis suggests that the children’s migration was induced by a lack of support and resources, followed by unequal educational opportunities. To deal with the gap left by their children, these older urban parents depend on kinship connection and community support in times of need. Government initiatives may also be able to empower the community in innovating and implementing plans which are tailored to the needs of the older parents left behind by children who have migrated. The living arrangements and recent bereavement experiences captured from the older couples can serve as cues for healthcare professionals and social support providers to assess the risks of social isolation and suicide among these left-behind older parents.
Malaysia

Omohyoid muscle syndrome (OMS) is one of the rare causes of lateral neck swelling during swallowing and it is often a worrisome observation due to the concern of malignancy and cosmetic deformity. Anatomical variation, congenital weakness, or trauma may cause incompetence of the fascial-retaining mechanism and subsequently OMS. Its prevalence is unknown as only a few cases were reported in the past and none in Malaysia. Diagnosing OMS is very challenging. Hence, imaging techniques like real time ultrasound or dynamic computed tomography can be useful in assessing the affected muscles.
Malaysia

Objective: To ascertain if the current standard for cataract surgery waiting time of 12 weeks or less in the UMMC Day Care Operation Theatre (OT) is > 80% met; and to identify the causes and possible measures to be taken if the standard is not met. Design: Retrospective analysis of patients’ medical records. Methods: The medical records of all patients who underwent cataract surgery in the Day Care OT between 1st October to 31st December 2017 were analysed. Results: A total of 230 patients underwent the surgery and from these, 219 patients were included. Only 63% of patients had a waiting time less than 12 weeks while 81.7% waited less than 16 weeks for the surgery. The common reasons found for the long waiting time were limited OT slots for cataract operations (71.6%), blepharitis (6.2%), uncontrolled co-morbidities (5%), patient requests (4.9%), financial problems, heart and lungs problems (1.2% each). Conclusion Out of 219 patients included in this audit, 63% underwent cataract surgery at our centre within 3 months. Of those who waited more than 3 months, 72% were due to limited OT slots. Further interventions should be carried out to improve the surgery waiting time and hence increase the quality of health services in the country.
Malaysia

Background: Metabolic syndrome (MS) is a major public health challenge worldwide. The risks of MS and chronic diseases are further escalated with the increasing burden of psychological health. This was a cross-sectional study aimed to investigate the relationship between socio-demographic, lifestyle and psychological factors and MS, as well as the independent relationship between social support and MS among school teachers in Malaysia. Methodology: Multi-stage sampling was used to recruit participants from the state of Malacca, Malaysia. Data on socio-demographics, lifestyle factors and psychological health were obtained using self-administered questionnaires, including Short-form International Physical Activity Questionnaire (IPAQ), Depression, Anxiety and Stress Scale (DASS-21), Job content questionnaire (JCQ) and the revised 8-item Malay version of the Multidimensional Scale Perceived Social Support (MSPSS-M). Anthropometric measurements and metabolic risk assessment were conducted. Univariate analysis followed by multiple logistic regressions was conducted using complex sample logistic regression analysis. Results: Of 1511 participants, the prevalence of MS was 23.3% (95% CI: 20.7, 26.1). MS was significantly associated with increasing age, male gender, Indian ethnicity, usage of saturated fats, lesser sleeping duration, job strain, iso-strain, and lower perceived social support. After adjusting for potential confounders, higher perceived social support from family, friends or both were significantly associated with the lower likelihood of MS by 4% (OR 0.96; 95% CI: 0.93, 0.98), 10% (OR 0.90; 95% CI: 0.85, 0.96) and 4% (OR 0.96; 95% CI: 0.94, 0.98), respectively. Conclusion Metabolic syndrome was associated with increasing age, male gender, Indian ethnicity, usage of saturated fats and lesser sleeping duration in our population. Psychological health such as job strain, iso strain as well as low social support may be modifiable risk factors for MS.
Malaysia

Introduction: Erectile dysfunction (ED) is common in men with diabetes and is associated with coronary artery disease and psychological distress. However, discussion of ED in primary care consultations is uncommon. Interventions, such as audit and feedback, mandate of management, and workshop on men’s sexual health, have been proposed to improve ED screening in public health clinics. This study aimed to pilot test a multi-faceted intervention to increase ED screening among men with diabetes and to improve knowledge and confidence in ED screening among primary healthcare providers (PHPs). Methods: We conducted an interrupted time-series quasi-experimental study with PHPs at public health clinics in Perak, Malaysia from February 2019 to February 2020. Doctors, nurses, and assistant medical officers involved in diabetes care were recruited. The intervention was conducted between July and September 2019 and comprised two phases: audit and feedback, and mandate from management (phase 1), and an interactive face-to-face workshop (phase 2). The primary outcome measure was monthly ED screening rate, and the data were retrieved from health records and the clinical diabetes registry. The PHPs completed a questionnaire on ED knowledge and confidence in ED screening before and after the workshop. Results: The total number of attendances by patients with diabetes was 50,325 during the study period, of which 21,413 were by men. A total of 30 PHPs participated in the training workshop: 7 (23.3%) doctors, 12 (40%) medical assistants, and 11 (36.7%) nurses. The mean duration of employment at a health clinic was 7 ± 5 years. The majority of the participants were male (56.7%), Malay (80%), married (76.7%), and had no experience with working in a urology department (76.7%). There was a significant improvement in the mean knowledge score (39.0 ± 11.4 vs. 63.6 ± 6.2, p<0.001) and median confidence level in ED screening from 2 (IQR 2–3) to 4 (IQR 4–4) after the workshop (p<0.001). After phase 1, the rate of ED screening increased from a baseline of between 10.3% (February 2019) and 12.7% (June 2019) before intervention to between 15% (July 2019) and 18.9% (September 2019) and was maintained between 18% (October 2019) and 17.9% (December 2019) after phase 2. Subsequently, the ED screening rate declined from 14.6% (January 2020) to 10.9% (February 2020). Conclusion This study found that audit and feedback with mandate from management increased ED screening and detection rate. The workshop improved the participants’ knowledge and confidence in ED screening but did not further increased ED screening. The improved practice was sustained for 6 months after the intervention, while the detection rate of ED persisted. We propose regular audit and feedback with mandate from management to sustain the practice of ED screening in men with diabetes.
Malaysia

Smoking ; Malaysia

Introduction: Psoriasis affects approximately 2–3% of the population worldwide, although the overall prevalence in Asia is <0.5%. Scalp psoriasis is a common initial presentation of psoriasis, which affects almost 80% of patients with psoriasis. Methods: This retrospective descriptive study investigated 1,671 patients with psoriasis with scalp involvement registered with the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018. Results: A total of 21,859 patients with psoriasis were registered with the MPR during the study period; among them, scalp involvement was seen in 7.6% (n=1,671). Female sex preponderance (61%) was observed in the majority of Malay patients (58.5%), followed by the Chinese (16.9%), Indian (17.1%) and other ethnic patients (7.5%). A positive family history of psoriasis was identified in 22.7% (n=380). Approximately 34.8% (n=581) and 11% (n=172) of the patients had nail changes and psoriatic arthropathy, respectively. The mainstay treatment modality was topical treatment (93.6%), followed by systemic therapy (10%) and phototherapy (0.5%). The comorbidities found among the patients with scalp psoriasis included hypertension (27.9%), obesity (26%), dyslipidaemia (21%), diabetes mellitus (18.4%), ischaemic heart disease (5.4%) and cerebrovascular disease (1.3%). Approximately 23% reported a Dermatology Life Quality Index (DLQI) of >10, which indicated moderate-to-severe impairment. Conclusion The proportion of patients with psoriasis with scalp involvement in our study (7.6%) is much lower than previous reports. Scalp psoriasis markedly negatively impacts the DLQI.
Malaysia ; Psoriasis

Introduction: SABINA III assessed short-acting β2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Methods: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1–2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27–0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44–2.89). Conclusion The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern.
Asthma ; Malaysia

No abstract available.
Humans ; India* ; Malaysia* ; Twins*